Lyndsey Anne Burton MD, Presenter: Nothing to Disclose

Theodore T. Miller MD, Abstract Co-Author: Stockholder, Johnson & Johnson

David Scher, Abstract Co-Author: Nothing to Disclose

Ronald Steven Adler MD, PhD, Abstract Co-Author: Consultant, Koninklijke Philips Electronics NV

The purpose of our study is to describe the ultrasound findings in six infants with CVT and to compare the imaging appearance of CVT using radiographs, sonography, and MR imaging

Six infants (12 feet), age range 1-19 months, with clinically suspected CVT were identified from the records of a single pediatric orthopaedic surgeon between 2006-2010. All 12 feet underwent sonographic evaluation, four had MR imaging, and nine had radiographs. Ultrasound was performed using an IU22 system (Philips, Inc. Bothell WA) with a 12-5 MHz transducer. The transducer was placed longitudinally along the dorsum of the midfoot, and CVT was diagnosed if the hypoechoic navicular was dorsal to the echogenic surface of the talar head. MR imaging was performed on 1.5T units (Signa Horizon, GE Medical Systems, Milwaukee, WI) with a dedicated coil. Sagittal, long axis, and short axis proton density sequences were performed. Radiographs consisted of anteroposterior, lateral, and oblique views. The radiographic diagnosis of CVT was made if the long axis of the talus was plantar to that of the first metatarsal.

CVT was clinically suspected in 11/12 feet. All 12 feet underwent sonographic imaging with CVT indentified in 10 feet. Nine of the feet were also imaged radiographically which demonstrated the deformity in six (and failed to identify two affected feet). Four feet had MR imaging which confirmed CVT in all four. One foot with clinically suspected CVT was shown to be negative on initial ultrasound and radiograph, as well as on a follow up ultrasound. Seven feet underwent surgical correction confirming the diagnosis. Of the three remaining feet (of the 10 feet with CVT confirmed on ultrasound), one had a follow up ultrasound after conservative treatment showing persistent CVT.

Sonography is superior to radiographs and equal to MRI for detection of CVT, and doesn’t require sedation.

We recommend ultrasound for 1.) Infants with insufficient ossification to diagnose CVT on radiographs 2.) Patients with an ossified talus and navicular, but with equivocal CVT radiographically.

Burton, L, Miller, T, Scher, D, Adler, R, Sonography of Congenital Vertical Talus.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007097.html